VK Case Study.pdf - UltraVision Group

www.kerasoft.co.uk®HistoryVK Clinical NotesVK is a 32 year old female who was diagnosed with keratoconus in 2007. Her brother also has keratoconusbut there is no other family history of the condition.In 2008, due to the fact her condition was progressing rapidly, she decided to undergo treatment with INTACsin both eyes to be followed by CXL some weeks later in each case. Her surgeon requested she be fitted withsoft contact lenses as soon as possible after each procedure in order to give her useful vision as she was inthe middle of a post graduate University course.Pre-operative FindingsSpectacle Refraction 14th April 2008:RE: +1.00/-6.00 x 75 VA 6/7.5 -1 LE: +1.50/-8.00 x 120 VA 6/12 -112th June 2008 - LE INTACs procedure1st July 2008 - First contact lens appointmentSpectacle acuity LE had deteriorated rapidly over the weeks following surgery. The surgeon requested thefitting of a temporary contact lens in the LE whilst the cornea was settling.Slit LampLeft conjunctiva exhibited some injection along with mild to moderate diffuse punctate staining over most ofthe corneal surface. VK was suffering acute photophobia and found it extremely difficult to be examined withany ophthalmic instrumentation.RxAn approximate refraction of LE: -9.00 DS was found by retinoscopy only.TopographyRE:LE:UltraVision International Ltd, Commerce Way, Leighton Buzzard, Beds, LU7 4RWUK Freephone 0800 585115 or +44 (0)1525 381112email: info@ultravision.co.uk web: www.ultravisiongroup.com

®VK Clinical Notes Cont’dA KeraSoft ® 3 lens 8.40/14.50/-10.00 was supplied for the LE with a resultant acuity of 6/15. Photophobiawas immediately reduced and VK felt much more comfortable and balanced with the LE corrected. Thisspherical lens was supplied to act as a powered bandage lens as the cornea settled down.14th August 2008 - RE INTACS procedure28th August 2008Now 2 weeks since INTACs surgery in RE. Both eyes were now very sensitive with significant photophobiawhich VK reported was much worse when she removed the left KeraSoft ® lens. RE acuity post operativelyhad initially been good but had deteriorated over the two weeks following surgery.TopographyRLSlit LampRE showed mild, central punctate staining and a fast tear break up time of 2-3 seconds. LE was clear andshowed no staining with Fluorescein.Spectacle RefractionRE: +4.00/-8.00 x 70 VA 6/12 LE: -12.00/-6.00 x 110 VA 6/24 +2Lens FittingVK reported her vision fluctuated markedly several times a day. After discussions with her and her surgeon,it was agreed to supply lenses with spherical power only at this juncture whilst the corneal shape was stillfluctuating markedly.Lenses supplied were KeraSoft ® 3 SiHRE: 8.40/14.50/-4.00 VA 6/15 LE: 8.40/14.50/-10.00 VA 6/15 Binoc 6/12October 2008 – CXL was performed on the LE at the beginning of the month and on the RE 2 weeks later.Following the CXL procedures, VK discontinued lens wear until the surgeon felt the corneas had settledsufficiently. During this period, she developed vascularisation around the upper edges of the INTACs in theLE, a known complication with the CXL procedure.November 2008After 4 weeks, the surgeon authorised returning to KeraSoft ® wear with continued monitoring, particularly inrespect to the post CXL vascularisation.UltraVision International Ltd, Commerce Way, Leighton Buzzard, Beds, LU7 4RWUK Freephone 0800 585115 or +44 (0)1525 381112email: info@ultravision.co.uk web: www.ultravisiongroup.com

®VK Clinical Notes Cont’dSlit LampBoth eyes were quiet showing no corneal staining with Fluorescein. The vascularisation of left superiorcornea was recorded for monitoring purposes.LE VascularisationKeraSoft ® FittingKeraSoft ® IC lenses were fitted and the full toric over prescription was now prescribed in order to optimiseacuity. The following lenses were supplied:RE: 8.50/15.00/STD/-1.50/-6.00 x 70 VA 6/12LE: 8.50/15.00/STD/-9.00/-2.00 x 150 VA 6/12Binocular acuity 6/9 +Whilst VK built up to all day wear, her vascularisation in the LE was monitored at regular intervals andremained unchanged. She reported that her photophobia was much reduced when she wore her lenses andalthough her vision continued to fluctuate daily, with or without lenses, she felt much more comfortable withthe lenses in situ. She had now reached a wearing time of approximately 12 hours.April 2009At this juncture, her vision was assessed to be settled enough to consider a fit adjustment. Although the leftprescription had changed significantly, she had reported that she had remained visually comfortable with herlenses.New KeraSoft ® IC lenses were supplied:RE: 8.20/14.50/STD/+3.00/-4.00 x 45 VA 6/9 -LE: 8.40/14.50/STD/Plano/-5.00 x 20 VA 6/9December 2009VK reported acuity still fluctuated daily but felt that there was an overall consistent change in her prescription.Both eyes remained quiet and the left superior vascularisation was unchanged.New KeraSoft ® IC lenses were prescribed:RE: 8.00/14.50/STD/-0.50/-6.00 x 60 VA 6/8 - LE: 8.20/14.50/STD/+0.50/-2.50 x 20 VA 6/8UltraVision International Ltd, Commerce Way, Leighton Buzzard, Beds, LU7 4RWUK Freephone 0800 585115 or +44 (0)1525 381112email: info@ultravision.co.uk web: www.ultravisiongroup.com

®VK Clinical Notes Cont’dMarch 2010VK reported that the left eye had improved again and she could see quite well now without a lens at all. Theleft spectacle refraction was now only -0.50DS but after trying no correction, spectacle correction and adisposable SiH contact lens, she felt most comfortable with the KeraSoft ® IC lens in place.Slit LampBoth corneas were clear showing no staining with fluorescein. Vascularisation in her LE was unchanged.Wearing time was now consistently all waking hours.The left lens was changed to reflect the corneal and prescription changes:KeraSoft ® ICLE: 8.00/14.50/STD/-0.50 VA 6/8 -1SummaryVK is a 32 year old female who underwent INTACs and CXL procedures on both eyes. The combined effectof these surgical interventions can result in corneal shape fluctuations that continue for many months. In thisparticular case, the left corneal shape has changed quite significantly over a period of 18 months. During thisperiod, KeraSoft ® lenses provided a valuable visual aid and considerably reduced significant photophobiawithout impacting adversely on the corneal shape changes or physiological health.Although vision fluctuated markedly during the post operative settling period, VK could continue for longperiods of time without needing frequent prescription changes.Differential Topography: Nov 08 (Lower images) – Mar 10 (upper images) showing the corneal changesproduced by the effects of INTACs and CXL that the left corneal shape in particular had changed significantlyfrom the pre operative topographies.RELEFinal KeraSoft ® IC LensesRE: 8.00/14.50/STD/-0.50/-6.00 x 60 VA 6/8 - LE: KeraSoft IC L: 8.00/14.50/STD/-0.50 VA 6/8 -1UltraVision International Ltd, Commerce Way, Leighton Buzzard, Beds, LU7 4RWUK Freephone 0800 585115 or +44 (0)1525 381112email: info@ultravision.co.uk web: www.ultravisiongroup.com